Authors (including presenting author) :
Cheung HH (1), Shek MK (1), Lui WK (1), Ng YB (1)
Affiliation :
(1) Medical and Geriatric, United Christian Hospital
Introduction :
PCR (GeneXpert) test for influenza A/B and RSV was used by the laboratory of United Christian Hospital. Tiny amount of viral RNA in upper-airway (Nasopharyngeal specimens) can trigger a positive result, however, the amount of RNA might be decreased to an undetectable level as the disease progressed to lower-airway. Thus, both LAS and Nasopharyngeal specimens act as crucial tools for management of influenza. In November, 2018, total 35 requests of LAS for influenza-PCR testing were made in ward 9B. In which, 15 specimens (43%) were collected within 24 hours. Room for improvement affirmed.
Objectives :
1. Improve efficiency of LAS for influenza collecting
2. Highlight the clinical importance of LAS to nurses
3. Increase commitment of staffs on specimens handling
Methodology :
1. Time-frame: December, 2018
2. Surveys and education of fundamental knowledge of LAS including the reasons of LA-specimen required other than Nasopharyngeal specimens and limitation of Nasopharyngeal specimens detection as disease progression.
3. LAS should be collected as soon as possible for cases with FTOCC or severe pneumonia. An clear algorithm established with guidelines from Infection Control Officer. For conscious and stable patients, specimens would be collected by patient self-providing with active follow-up. For conscious patients with sputum yielding difficulty, saline nebulizer with appropriated infection control measures and chest physiotherapy referral would be made. Sputum suction would be considered if agreed by patients. For confused/unconscious or critical ill or patient with mechanical ventilation support, sputum suction with chest physiotherapy would be actively performed. 4. Uncollected LAS would be screened daily and immediately recommendation and follow-up provided by designated staffs.
Result & Outcome :
1. Majority of nurses do not clear the limitation of Nasopharyngeal specimens and the clinical importance of LAS. Reinforcement was done via in-service seminars with positive feedback. 2. Clear pathway provided through an algorithm as feedbacked and the resources available in assisting LAS collecting was acknowledged by nurses. 3. In December, 2018, total n=37 requests of LAS for influenza-PCR testing were made in ward 9B. In which, 31 specimens (83%) were collected within 24 hours from the time of request. 40% improvement achieved. 4. 64.9% of LAS was screened and collected by designated staffs. Workload of nurses was significantly relieved in term of specimens collecting.
5. Positive feedback was received including: enhancing surveillance of influenza, promoting safer working environment, improved achievement of patient care.
Co-location with:
